Establishing the Exchange

Prior to the announcement, the Pennsylvania Insurance Department had taken the lead with exchange planning. The Insurance Department, released an extensive report in November 2011 that suggested broad support for a state-run exchange.2 In January 2012, the Department released a conceptual draft for proposed legislation which would establish multiple private exchanges overseen by the Department.3 Consumer representatives expressed concern over the proposed model, citing such an approach would be inconsistent with the exchange requirements under the Affordable Care Act (ACA).4 In May 2012, the Department had begun soliciting for a subcontractor to provide guidance and consultation on exchange planning.5

Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Pennsylvania has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Aetna POS.

Exchange Funding

In September 2010, the Pennsylvania Insurance Department was awarded a $1 million federal Exchange Planning grant. In February 2012, the Department was awarded a $33.8 million federal Level One Establishment grant to continue with exchange planning and the procurement of technical expertise.6

Next Steps

The federal government will assume full responsibility for running a health insurance exchange in Pennsylvania beginning in 2014.